Differences in receipt of guideline-compliant care and survival for early-onset versus average-onset biliary tract cancers

Background We examined differences in receipt of guideline-compliant care in patients with early-onset versus average-onset biliary tract cancers (BTC) in localized or metastatic settings. Additionally, we examined associations between guideline compliance and overall survival (OS), stratified by age of onset and clinical stage. Methods Patients with BTC [intrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma] were identified within the National Cancer Database (2010–2018). Early onset was defined as diagnosis at < 50 and average onset at ≥ 70 years. Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease. Results A total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease. Conclusions Early-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. Guideline compliance is associated with improved OS regardless of age of onset or clinical stage.